Access and Reimbursement for Infectious Disease Services

Fair and adequate reimbursement for infectious diseases physicians is a key IDSA policy priority. The Society also advocates for access to appropriate treatments for patients with serious infections and for medical liability reform. IDSA’s positions on specific reimbursement and access issues that impact the practice of infectious diseases and Advocacy Alerts to key policy priorities are provided below.

IDSA has joined 31 other organizations to provide comments on the National Quality Forum (NQF) Measure Endorsement Process. The undersigned organizations believe that there are still deficiencies that need to be resolved, specifically around endorsement review timelines, the implementation of updated evaluation criteria, measure testing, and eMeasure requirements.

IDSA was joined by 33 other organizations in a letter to the Centers for Medicare & Medicaid Services (CMS) advocating that hospitals and long-term care facilities be required to implement an antibiotic stewardship program (ASP) as a Condition of Participation (COP) in Medicare and Medicaid. CMS is known to be actively considering the proposal. The recommednation was also made by the President's Council of Advisors on Science and Technology (PCAST) in their recent report on combatting antibiotic-resistant bacteria.

IDSA jointly applauds the efforts of the Ensuring Access to Primary Care for Women & Children Act, S. 2694. This legislation will help ensure Medicaid enrollees have access to vital primary care services delivered by primary care and related subspecialty physicians, by extending current-law payment rates under Medicaid for certain primary care and immunization services to at least the level of Medicare through 2016.

IDSA signed onto a Cognitive Specialties Coalition providing input to the House and Senate committees working on a repeal of the Sustainable Growth Rate (SGR). The letter expresses general support for a repeal of the SGR and more specifically calls on Congress to: provide positive payment updates moving forward, adopt a threshold scoring model as opposed to a competitive one, and to include cognitive specialists in measures to encourage chronic care management and practice enhancements.

IDSA wrote in support of the Senate Finance and House Ways and Means Committees' November 2013 discussion draft of a bill to repeal the Sustainable Growth Rate (SGR) and simplify current value-based payment programs. The letter also called on Congress to consider periodic physician payment increases, as well as provided detailed recommendations on a host of issues in the congressional draft related to quality and assessment.

As part of a collective of numerous state medical associations and national medical societies, IDSA urges the Centers for Medicare & Medicaid Services (CMS) to take immediate action to ensure that Medicare beneficiaries participating in Medicare Advantage (MA) plans have accurate and reliable information to make health insurance elections during the 2014 Open Enrollment period, and to address a lack of MA sponsor transparency on network adequacy.

IDSA comments on the United States Preventive Services Task Force (USPSTF) Draft Recommendation Statement on Screening for Hepatitis C Virus Infection in Adults. IDSA requests USPSTF to change the conservative grade of "C" to "B" in order to identify approximately 800,000 new infections and save 121,000 lives.

IDSA joined with members of the Cognitive Specialty Coalition in requesting that CMS rescind its approval of the Recovery Audit Contractor (RAC) program to include audits of evaluation and management (E/M) codes in physician offices.

IDSA submitted comments to CMS on the proposed rule related to the Medicare & Medicaid Conditions of Participation (CoP). This letter advocated for inclusion of "Antimicrobial Stewardship Programs" as part of Infection Control requirements outlined in the CoP. As well, the letter also supported CMS' proposal to expand the use of hospital standing orders in a way that would promote immunization rates.

IDSA and other groups whose physicians primarily provide "evaluation and management" services expressed concern with a proposal to address the Medicare SGR that includes a modest payment increase for primary care physicians defined to exclude cognitive specialists who primarily bill "evaluation and management services"--using the same codes and providing the same services as primary care physicians.

IDSA joined the American Medical Association and other physician groups on another letter to continue urging the Joint Select Committee on Deficit Reduction to repeal the flawed medicare Sustainable Growth Rate (SGR) formula as part of their legislation to be considered by Congress by the end of the year.